Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G26529 | CA |
NPI | 1033287545 |
---|---|
Provider Name | Dr. Kenneth B Wiesner |
First Address | Sacramento, CA 95825-6300 |
Second Address | Sacramento, CA 95825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 09/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43026 | (02) |